<?
if ($id<>1 && $id<>2){
	header("Location: https://www.boxwiper.jp/index.php");
}
?>

<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
<!--[if lt IE 9]>
    <script src="http://css3-mediaqueries-js.googlecode.com/svn/trunk/css3-mediaqueries.js"></script><![endif]-->
<meta name="viewport" content="width=device-width, initial-scale=1.0;maximum-scale=1.0; user-scalable=no">
<title>Survey</title>
<link rel="stylesheet" href="<?php echo base_url(); ?>assets/css/cssSurvey.css" type="text/css" media="screen" />
<script type="text/javascript" src="<?php echo base_url(); ?>assets/js/jquery.js"></script>
<script type="text/javascript" src="<?php echo base_url(); ?>assets/js/validate.js"></script>
<script type="text/javascript" src="<?php echo base_url(); ?>assets/js/hanzenkaku.js"></script>
<script type="text/javascript" src="<?php echo base_url(); ?>assets/js/area.js"></script>
<script>
    

function isNumberKey(evt,obj)
{	
    $return = true;
    var charCode = (evt.which) ? evt.which : evt.keyCode;
	//setvalue();
	
    if ( charCode > 31
            && (charCode < 48 || charCode > 57))
        $return = false;
	
    
	
    return $return;
}
function onClick(){
		/*var result = getErrors();
		alert(result);*/
	/*if ($('#ok:checked').val() ){
		//$('#formMain').submit();
		
	}else{
		alert('応募規約に同意して下さい。');
		return false;
		
	}*/
	//test_m();
	//alert(123123123);
	//getErrors();
	var errorList = getErrors('i_id1','i_id2','cource','i_contactNameFirst','i_contactNameSecond','i_contactNameFirstKana','i_contactNameSecondKana',
							'i_schoolName','i_schoolPosition','i_email','i_emailConf','i_zip1','i_zip2','i_setting_area2_id','i_cityName','i_townName',
							'i_tel1','i_tel2','i_tel3', 'i_addressbuy');
                                                        
        
        
       
	var div = document.getElementById('errorMessage');	
	div.innerHTML = "";

        var div1 = document.getElementById('errorMessage1');
        div1.innerHTML = "";
        
         if(errorList.length ==0){
                div1.innerHTML +='エラーです、最初からやり直して下さい。'+'<br>';
         }
        var err = checkButons5();
        if(err != ""){
            div1.innerHTML +=  '●' + err + '<br>';
        }
        var err2 = checkButons4();
        if(err2 != ""){
            div1.innerHTML +=  '●' + err2 + '<br>';
        }
        
        <?php if($id == 2){?>
            
        var err3 = checkButons3();
        if(err3 != ""){
            div1.innerHTML +=  '●' + err3 + '<br>';
        }
        
        
        var err4 = checkButons2();
        if(err4 != ""){
            div1.innerHTML +=  '●' + err4 + '<br>';
        }
        
        
        var err5 = checkButons1();
        if(err5 != ""){
            div1.innerHTML +=  '●' + err5 + '<br>';
        }
        
        
        var err6 = checkButons();
        if(err6 != ""){
            div1.innerHTML +=  '●' + err6 + '<br>';
        }
        
        
        <?php }?>
        <?php if($id == 1){?>
            
        var err8 = checkButons7();
        if(err8 != ""){
            div1.innerHTML +=  '●' + err8 + '<br>';
        }
        var err7 = checkButons6();
        if(err7 != ""){
            div1.innerHTML +=  '●' + err7 + '<br>';
        }

        
        <?php }?>
        
	if( errorList.length != 0){
	
	$('#errorMessage').css('display', 'block');
        div.scrollIntoView();
	
		div.innerHTML += 'エラーがあります。'+'<br>';
		
		for(var i = 0 ; i < errorList.length; i ++ ){
			if(errorList[i].length > 1)
			{
				for(var j = 0 ; j < errorList[i].length; j ++ ){
					div.innerHTML += '●' + errorList[i][j]+ '<br>';
				}
			}
			else div.innerHTML +=  '●' + errorList[i] + '<br>';
		}
                
                //
                //
               
//
//alert(errorList[0]);
		//document.getElementById('errorMessage').innerHTML = "adasdasdasd111111111111111111111111111";
               return false;
        }
        
        else{
        
             <?php if($id==1) { ?>
                     if(err.length > 0 || err2.length > 0 || err7.length > 0 ||err8.length > 0){$('#errorMessage1').css('display', 'block'); div1.scrollIntoView(); return false;} else { $('#formMain').submit();}
                    <?php } else if($id==2){?>
                         if(err.length > 0 || err2.length > 0 ||err3.length > 0 ||err4.length > 0 ||err5.length > 0 ||err6.length > 0 ){$('#errorMessage1').css('display', 'block'); div1.scrollIntoView(); return false;}else { $('#formMain').submit();}
                    <?php } ?>
        }
	//alert(str_error);
	
		//alert(result);

	//var check = detectZenKaku('４月');
	//alert(check);
	//var check = iskatakana("応募");
	//alert(check);
	
	//var check = checkEmail('binhck2@gmail.com');
	//alert(check);
	//var value = checkArea('i_setting_area2_id');
	//alert(value);
        
        
}

function onOKCheck(){

	if ($('#ok:checked').val() ){
		$('#oubo').css('display', 'block');
		$('#oubo_off').css('display', 'none');
                
	}else{
		$('#oubo_off').css('display', 'block');
		$('#oubo').css('display', 'none');
	}

}

</script>
<script>
	$(document).ready(function(){
		$('#oubo_off').css('display', 'block');
		$('#oubo').css('display', 'none');
		$('#errorMessage').css('display', 'none');
                $('#errorMessage1').css('display', 'none');
                
	});

</script>

<style type="text/css">
   (function ($) {
    "use strict";

    // Detecting IE
    var oldIE;
    if ($('html').is('.ie6, .ie7, .ie8')) {
        oldIE = true;
    }

    if (oldIE) {
        <script src="http://css3-mediaqueries-js.googlecode.com/svn/trunk/css3-mediaqueries.js"></script>
    } else {
        // ..And here's the full-fat code for everyone else
    }

}(jQuery));

</style>
</head>
<body >

	<div id="pagewrap">
<!--
		<div id="header">
			<img  src="<?php echo base_url(); ?>assets/image/Header_01.png" />
		</div>
-->
		<div id="content">
		<div class="error" id ="errorMessage"></div>
                <div class="error" id ="errorMessage1" style="border:none;"></div>
		<div class="titleSurvey">
		
			<?php if($id==1){?><img  src="<?php echo base_url(); ?>assets/image/title6.png" />
			<?php } else { ?> <img  src="<?php echo base_url(); ?>assets/image/title1.png" /><?php }?>
		</div>
                <script type="text/javascript">
                function checkButons() {
                        var re = false;
                        var re2 = false// used to determine when a button is checked
                        var err = '';             // to store the errors

                        var q8 = document.getElementsByName('q8[]');
                                 // contains an array with all radio buttons "vegetable"

                        // create an Array in JSonn format with checkbox buttons

                        // traverse the radio buttons
                        // if one is checked sets re to true, and stops the iteration with "break"
                        for(var i=0; i<q8.length; i++) {
                          if(q8[i].checked == true) {
                            re = true;
                            break;
                          }
                        }

                        // if "re" is false means no radio button checked, add error in "err" 
                        if(re == false){
                            err += '布ウエスの併用をお選び下さい。';
                        }else{
                            re = false;
                            var q9 = document.getElementsByName('q9[]');
                            for(var i=0; i<q9.length; i++) {
                                if(q9[i].checked == true) {
                                    re = true;
                                    break;
                                }
                            }
                            if (re == false){
                                err += '布ウエスと併用しているものをお選び下さい。';
                            }else{
                                var test = document.getElementById('q9text').value;
                                if(re == true && q9[6].checked == true){
                                    if (test == null || test == "") {
                                       err += '布ウエスと併用しているその他を入力して下さい。';
                                    }
                           
                            }
                            } 
                        // if "re" is false means no checkbox button checked, add error in "err" 
                        
                        

                        
                        } 

                        // make "re" again False, and traverse the checkbox buttons
                        // if one is checked sets re to true, and stops the iteration with "break"
 
                        
                       
                            return err;
                        }
                        
                     
                     function checkButons1(){
                        var re = false;
                    
                        // used to determine when a button is checked
                        var err = '';             // to store the errors
                        var q6 = document.getElementsByName('q6[]');
                             // contains an array with all radio buttons "vegetable"

                        // create an Array in JSonn format with checkbox buttons

                        // traverse the radio buttons
                        // if one is checked sets re to true, and stops the iteration with "break"
                        for(var i=0; i<q6.length; i++) {
                          if(q6[i].checked == true) {
                            re = true;
                            break;
                          }
                        }

                        // if "re" is false means no radio button checked, add error in "err" 
                        if(re == false){
                            err += 'キムタオルの使用方法をお選び下さい。';
                        }else{
                            re = false;
                            var q7 = document.getElementsByName('q7[]');
                            for(var i=0; i<q7.length; i++) {
                              if(q7[i].checked == true) {
                                re = true;
                                break;
                              }
                            }
                            // if "re" is false means no checkbox button checked, add error in "err" 
                            if (re == false){
                                err += 'キムタオルを濡らす液体を教えて下さい。';
                            }else{
                                var test = document.getElementById('q7text').value;
                                if(q7[3].checked == true){
                                if (test == null || test == "") {
                                    err += 'キムタオルを濡らす液体を教えて下さい。';
                                }
                           
                            }
                            }
                        } 

                        // make "re" again False, and traverse the checkbox buttons
                        // if one is checked sets re to true, and stops the iteration with "break"
                        // if "err" not empty, alert the error(s) and returns False to stop submitting form
                        return err;
                     }
                     
                     function checkButons2(){
                        var re = false;
                        var re2 = false;
                        // used to determine when a button is checked
                        var err = '';             // to store the errors
                        
  
                        var q420 = document.getElementById("id1");
                        var q421 = document.getElementById("id2");
                        var q422 = document.getElementById("id3");
                        var q423 = document.getElementById("id4");
                        var q424 = document.getElementById("id5");
                        var q425 = document.getElementById("id6");
                        
                        var q = [q420, q421, q422, q423, q424, q425];
                        
                        for(var i=0; i<q.length; i++) {
                          if(q[i].checked == true) {
                            re = true;
                            break;
                          }
                        }
                        
                   
                        
                        
                        // if "re" is false means no checkbox button checked, add error in "err" 
                        if (re == false){
                            err += 'キムタオルの使用用途をお選び下さい。';
                        }else{
                            re = false;
                            if(q[0].checked == true){
                            var q11 = document.getElementById("id11");
                            var q12 = document.getElementById("id12");
                            var q13 = document.getElementById("id13");
                            var q14 = document.getElementById("id14");
                            var q15 = document.getElementById("id15");
                            var q1 = [q11, q12, q13, q14, q15];
                            for(var i=0; i<q1.length; i++) {
                                if(q1[i].checked == true) {
                                    re = true;
                                    break;
                                }
                            }
                            if(re == false){
                                err += 'キムタオルの汚れの拭き取り内容をお選び下さい。';
                            }
                            else{
                               var test = document.getElementById('q42text').value;
                            
                            if(q1[4].checked == true){
                                if(test == null || test == ""){
                                    re = false;
                                    err += 'キムタオルの汚れの拭き取り内容（その他）を入力して下さい。';
                                }else{
                                    re = true;
                                }
                                
                            } 
                            }   
                            
                        }else{
                            var q11 = document.getElementById("id11");
                            var q12 = document.getElementById("id12");
                            var q13 = document.getElementById("id13");
                            var q14 = document.getElementById("id14");
                            var q15 = document.getElementById("id15");
                            var q1 = [q11, q12, q13, q14, q15];
                            for(var i=0; i<q1.length; i++) {
                                if(q1[i].checked == true) {
                                    re = false;
                                    break;
                                }
                            }
                        }
                        
                        
                        
                      
                        var test = document.getElementById('q5text').value;
                        if(re == true && q[5].checked == true){
                            if (test == null || test == "") {
                                re = false;
                                err += '使用用途のその他を入力して下さい。';
                            }
                            else
                                re = true;
                        }
                        } 
                        
                        
                        

                        // if "err" not empty, alert the error(s) and returns False to stop submitting form
                       
                        return err;
                     }
                     
                     function checkButons3(){
                         var re = false;           // used to determine when a button is checked
                        var err = '';             // to store the errors

                        
                        var q32 = document.getElementsByName('q32[]');
                        for(var i=0; i<q32.length; i++) {
                          if(q32[i].checked == true) {
                            re = true;
                            break;
                          }
                        }
                        // if "re" is false means no checkbox button checked, add error in "err" 
                        if (re == false){
                            err += '業種をお選び下さい。';
                        }else{
                            var test = document.getElementById('q32text').value;
                        //var test = document.getElementsByName('q32text').val;
                            if(re == true && q32[13].checked == true){
                            if (test == null || test == "") {
                               err += 'その他の業種を入力して下さい。';
                            }
                       
                        }
                        } 
                        
                        
                        return err;
                     }
                     
                      function checkButons4(){
                       var re = false;           // used to determine when a button is checked
                        var err = '';             // to store the errors

                                // contains an array with all radio buttons "vegetable"
                                
                        var q2 = document.getElementsByName('q2[]');
                        // create an Array in JSonn format with checkbox buttons

                        // traverse the radio buttons
                        // if one is checked sets re to true, and stops the iteration with "break"
                        for(var i=0; i<q2.length; i++) {
                          if(q2[i].checked == true) {
                            re = true;
                            break;
                          }
                        }

                        // if "re" is false means no radio button checked, add error in "err" 
                        if(re == false){
                            err = '月間購入量をお選び下さい。';
                        } 

                        return err;
                     }
                     
                     function checkButons5(){
                        
                        var re = false;           // used to determine when a button is checked
                        var err = '';             // to store the errors

                        
                        var q1 = document.getElementsByName('q1[]');
                        for(var i=0; i<q1.length; i++) {
                          if(q1[i].checked == true) {
                            re = true;
                            break;
                          }
                        }
                        // if "re" is false means no checkbox button checked, add error in "err" 
                        if (re == false){
                            err = 'ご購入商品をお選び下さい。';
                        } 
                        
                        // if "err" not empty, alert the error(s) and returns False to stop submitting form
                        return err;
                     }
                     
                     
                     //get error enq1.inc
                     
                     function checkButons6(){
                        var re = false;           // used to determine when a button is checked
                        var err = '';             // to store the errors

                        
                        var q41 = document.getElementsByName('q41[]');
                        for(var i=0; i<q41.length; i++) {
                          if(q41[i].checked == true) {
                            re = true;
                            break;
                          }
                        }
                        // if "re" is false means no checkbox button checked, add error in "err" 
                        if (re == false) err += '使用用途をお選び下さい。';
                        
 
                        return err;
                     }
                     
                     
                     function checkButons7(){	
                       var re = false;           // used to determine when a button is checked
                       var err = '';             // to store the errors
                       var q41 = document.getElementsByName('q31[]');
                         // contains an array with all radio buttons "vegetable"

                        // create an Array in JSonn format with checkbox buttons

                        // traverse the radio buttons
                        // if one is checked sets re to true, and stops the iteration with "break"
                        for(var i=0; i<q41.length; i++) {
                          if(q41[i].checked == true) {
                            re = true;
                            break;
                          }
                        }

                        // if "re" is false means no radio button checked, add error in "err" 
                        if(re == false){
                            err += '業種をお選び下さい。';
                        }else{
                            var test = document.getElementById('q31text').value;

                            if(q41[6].checked == true){
                            if (test == null || test == "") {
                                err += 'その他の業種を入力して下さい。';
                            }
                            
                        }
                        } 

                        
                        
                        
                       return err;
                     }
                </script>
                <form action="<?php echo site_url('addSurvey') .'?id='.$id; ?>" method="post" id ="formMain">
						<!-- Row 1-->
                                                
					  <div class="row">
							<div  class="title">
								<table>
									<tbody>
										<tr>
											<th style="font-weight:900; font-style:bold; padding:10px;"><label class="lb3">応募ID(14ケタ)</label></th>
											<th width="50"><img class ="td-icon" src="<?php echo base_url(); ?>assets/image/title2.png" ></th>
										</tr>
									</tbody>
								</table>
							</div>
							<!--<label class="desc" id="title1" for="Field1">応募ID(14ケタ)<img src="<?php echo base_url(); ?>assets/image/2_PC_キムタオル_入力_03.png" width="20" height="10"></img></label>-->
							<div class="fieldColumn" >

								  1枚目 <input id="i_id1" name="idsp1" type="text" class="type1" value="" size="8" maxlength="14" tabindex="1" ><br>
								  2枚目 <input id="i_id2" name="idsp2" type="text" class="type1" value="" size="8" maxlength="14" tabindex="1"> <br>
									A賞・B賞への応募の方は応募ＩＤを２つ入力して下さい。<br />
									C賞・D賞への応募の方は応募ＩＤを１つ入力して下さい。
								</div>
							</div>
							
					<!-- Row 2-->
					<div class="row">
							<div  class="title">
								<table>
									<tbody>
										<tr >
											<th style="font-weight:900; padding:10px;" ><label class="lb3">ご希望のコースをお選び下さい。</label></th>
											<th width="50"><img class ="td-icon" src="<?php echo base_url(); ?>assets/image/title2.png" ></th>
										</tr>
									</tbody>
								</table>
							</div>
							<!--<label class="desc" id="title1" for="Field1">応募ID(14ケタ)<img src="image/2_PC_キムタオル_入力_03.png" width="20" height="10"></img></label>-->
							<div class="fieldColumn" >
							<!--
								<div class ="rowFieldColumn" >
									<div class="field1"><img src="image/a1.png" /></div>
									<div class="field2"><input name="cource" id="i_cource_0"  value="1" type="radio"><label for="i_cource_0">A賞（応募ID2枚）<br>キムワイプオリジナルBRUNOハイブリッド加湿器フォルテミストwhite</label></div>
									<p style="clear:both;"></p>
								</div>
								<div class ="rowFieldColumn" >
									<div class="field1"><img src="image/a1.png" /></div>
									<div class="field2"><input name="cource" id="i_cource_1"  value="2" type="radio"><label for="i_cource_1">A賞（応募ID2枚）<br>キムワイプオリジナルBRUNOハイブリッド加湿器フォルテミストwhite</label></div>
									<p style="clear:both;"></p>
								</div>
								<div class ="rowFieldColumn" >
									<div class="field1"><img src="image/a1.png" /></div>
									<div class="field2"><input name="cource" id="i_cource_2"  value="3" type="radio"><label for="i_cource_2">A賞（応募ID2枚）<br>キムワイプオリジナルBRUNOハイブリッド加湿器フォルテミストwhite</label></div>
									<p style="clear:both;"></p>
								</div>
								<div class ="rowFieldColumn" >
									<div class="field1"><img src="image/a1.png" /></div>
									<div class="field2"><input name="cource" id="i_cource_3"  value="4" type="radio"><label for="i_cource_3">A賞（応募ID2枚）<br>キムワイプオリジナルBRUNOハイブリッド加湿器フォルテミストwhite</label></div>
									<p style="clear:both;"></p>
								</div>-->
								<table>
									<tbody>
										<tr>
											<td width="50%" style="padding-left:5px;"><img src="<?php echo base_url(); ?>assets/image/a.jpg" /></td>
											<td width="50%"  style="padding-left:5px;"><img src="<?php echo base_url(); ?>assets/image/b.jpg" /></td>
										</tr>
										<tr>
											<td width="50%"><table><tbody><tr><td valign="top" width="15"><input name="cource" id="i_cource_0"  value="1" type="radio"></td><td><label for="i_cource_0" class="lb5">A賞（応募ID2枚）<br>キムワイプオリジナル<br>BRUNOハイブリッド加湿器<br>フォルテミストwhite</td></tr></tbody></table></td>
											<td width="50%"><table><tbody><tr><td valign="top" width="15"><input name="cource" id="i_cource_1"  value="2" type="radio"></td><td><label for="i_cource_1" class="lb5"> B賞（応募ID2枚）<br>キムタオルオリジナル<br>タイガーポータブルクーラー<br>保温・保冷9.5L</td></tr></tbody></table></td>
										</tr>
										<tr>
											<td width="50%" style="padding-left:5px;"><img src="<?php echo base_url(); ?>assets/image/c.jpg" /></td>
											<td width="50%"  style="padding-left:5px;"><img src="<?php echo base_url(); ?>assets/image/d.jpg" /></td>
										</tr>
										<tr>
											<td width="50%"><table><tbody><tr><td valign="top" width="15"><input name="cource" id="i_cource_2"  value="3" type="radio"></td><td><label for="i_cource_2"  class="lb5">C賞（応募ID1枚）<br>オリジナルマグカップ4個セット</td></tr></tbody></table></td>
											<td width="50%"><table><tbody><tr><td valign="top" width="15"><input name="cource" id="i_cource_3"  value="4" type="radio"></td><td><label for="i_cource_3"  class="lb5"> D賞（応募ID1枚）<br>オリジナルトランプ&nbsp;&nbsp;&nbsp;&nbsp;</td></tr></tbody></table></td>
										</tr>
									</tbody>
								</table>

							</div>
							
							
					</div>
						
					<!-- ROW 3 -->
					<div class="row">
							<div  class="title">
								<table>
									<tbody>
										<tr>
											<th style="font-weight:900; padding:10px;"><label class="lb3">勤務先(学校)ご住所<br>（全角文字で入力して下さい）</label></th>
											<th width="50"><img class ="td-icon" src="<?php echo base_url(); ?>assets/image/title2.png" ></th>
										</tr>
									</tbody>
								</table>
							</div>
							<!--<label class="desc" id="title1" for="Field1">応募ID(14ケタ)<img src="image/2_PC_キムタオル_入力_03.png" width="20" height="10"></img></label>-->
							<div class="fieldColumn" >
									<!---ROW3-->
								  <div class="col1"><input id="i_schoolName" name="workplace" type="text" class="type3" value="" size="8" tabindex="1"></div>
							</div>
					</div>
					
					<!-- ROW 4 -->
					<div class="row">
							<div  class="title">
								<table>
									<tbody>
										<tr>
											<th style="font-weight:900; padding:10px;"><label class="lb3">部署名</label><br><label class="lb3">（学部・学科・研究室名)</label></th>
											<th width="50"><img class ="td-icon" src="<?php echo base_url(); ?>assets/image/title2.png" ></th>
										</tr>
									</tbody>
								</table>
							</div>
							<!--<label class="desc" id="title1" for="Field1">応募ID(14ケタ)<img src="image/2_PC_キムタオル_入力_03.png" width="20" height="10"></img></label>-->
							<div class="fieldColumn" >
									<!---ROW3-->
								  <div class="col1"><input id="i_schoolPosition" name="department" type="text" class="type3" value="" size="8" tabindex="1"></div>
							</div>
					</div>
					<!---ROW5-->
					 <div class="row">
							<div  class="title">
								<table>
									<tbody>
										<tr>
											<th style="font-weight:900; padding:10px;"><label class="lb3">お名前</label></th>
											<th width="50"><img class ="td-icon" src="<?php echo base_url(); ?>assets/image/title2.png" ></th>
										</tr>
									</tbody>
								</table>
							</div>
							<!--<label class="desc" id="title1" for="Field1">応募ID(14ケタ)<img src="<?php echo base_url(); ?>assets/image/2_PC_キムタオル_入力_03.png" width="20" height="10"></img></label>-->
							<div class="fieldColumn" >
									<!---ROW3-->
								  <div class="col1">姓 <input id="i_contactNameFirst" name="name1" type="text" class="type2" value="" size="8" tabindex="1"></div>
								   <div class="col1">名 <input id="i_contactNameSecond" name="name2" type="text" class="type2" value="" size="8" tabindex="1"> </div>
				
							</div>
					</div>
					
					<!-- ROW 6 -->
					<div class="row">
							<div  class="title">
								<table>
									<tbody>
										<tr>
											<th style="font-weight:900; padding:10px;"><label class="lb3">フリガナ（全角）</label></th>
											<th width="50"><img class ="td-icon" src="<?php echo base_url(); ?>assets/image/title2.png" ></th>
										</tr>
									</tbody>
								</table>
							</div>
							<!--<label class="desc" id="title1" for="Field1">応募ID(14ケタ)<img src="<?php echo base_url(); ?>assets/image/2_PC_キムタオル_入力_03.png" width="20" height="10"></img></label>-->
							<div class="fieldColumn" >
									<!---ROW3-->
								  <div class="col1">セイ <input id="i_contactNameFirstKana" name="namekana1" type="text" class="type2" value="" size="8" tabindex="1"></div>
								   <div class="col1"> メイ <input id="i_contactNameSecondKana" name="namekana2" type="text" class="type2" value="" size="8" tabindex="1"> </div>
				
							</div>
					</div>
				
					
					<!-- ROW 7 -->
					<div class="row">
							<div  class="title">
								<table>
									<tbody>
										<tr>
											<th style="font-weight:900; padding:10px;"><label class="lb3">性別</label></th>
											<th width="50"><img class ="td-icon" src="<?php echo base_url(); ?>assets/image/title2.png" ></th>
										</tr>
									</tbody>
								</table>
							</div>
							<!--<label class="desc" id="title1" for="Field1">応募ID(14ケタ)<img src="<?php echo base_url(); ?>assets/image/2_PC_キムタオル_入力_03.png" width="20" height="10"></img></label>-->
							<div class="fieldColumn" >
									<!---ROW3-->
								  <div class="col1"><input name="sex" id="sex_male"  value="男" type="radio" class="type6" checked><label for="sex_male" style="font-size:15px;">男&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
								  <input name="sex" id="sex_famale"  value="女" type="radio" class="type6"><label for="sex_famale" style="font-size:15px;">女
								  </div>
							</div>
					</div>
					
					<!-- ROW 7 -->
					<div class="row">
							<div  class="title">
								<table>
									<tbody>
										<tr>
											<th style="font-weight:900; padding:10px;"><label class="lb3">メールアドレス</label></th>
											<th width="50"><img class ="td-icon" src="<?php echo base_url(); ?>assets/image/title2.png" ></th>
										</tr>
									</tbody>
								</table>
							</div>
							<!--<label class="desc" id="title1" for="Field1">応募ID(14ケタ)<img src="<?php echo base_url(); ?>assets/image/2_PC_キムタオル_入力_03.png" width="20" height="10"></img></label>-->
							<div class="fieldColumn" >
									<!---ROW3-->
								  <div class="col1"><input id="i_email" name="email" type="text" class="type7" value="" size="8" tabindex="1"></div>
							</div>
					</div>
					<!-- ROW 8 -->
					<div class="row">
							<div  class="title">
								<table>
									<tbody>
										<tr>
											<th style="font-weight:900; padding:10px;"><label class="lb3">メールアドレス(確認用)</label></th>
											<th width="50"><img class ="td-icon" src="<?php echo base_url(); ?>assets/image/title2.png" ></th>
										</tr>
									</tbody>
								</table>
							</div>
							<!--<label class="desc" id="title1" for="Field1">応募ID(14ケタ)<img src="<?php echo base_url(); ?>assets/image/2_PC_キムタオル_入力_03.png" width="20" height="10"></img></label>-->
							<div class="fieldColumn" >
									<!---ROW3-->
								  <div class="col1"><input id="i_emailConf" name="emailconf" type="text" class="type7" value="" size="8" tabindex="1"><br><div style="width:150%;">コピーせずにご入力下さい。 </div></div>
							</div>
					</div>
					
					<!-- ROW 9 -->
					<div class="row1">
						<label class="lb4">勤務先(学校)ご住所 </label>
					</div>
					
					<!-- ROW 10 -->
					<div class="row">
							<div  class="title">
								<table>
									<tbody>
										<tr>
											<th style="font-weight:900; padding:10px;"><label class="lb3">郵便番号</label></th>
											<th width="50"><img class ="td-icon" src="<?php echo base_url(); ?>assets/image/title2.png" ></th>
										</tr>
									</tbody>
								</table>
							</div>
							<!--<label class="desc" id="title1" for="Field1">応募ID(14ケタ)<img src="<?php echo base_url(); ?>assets/image/2_PC_キムタオル_入力_03.png" width="20" height="10"></img></label>-->
							<div class="fieldColumn" >
									<!---ROW3-->
								  <div class="col1"><input id="i_zip1" name="zip1" type="text" class="type4" value="" size="3" maxlength="3" tabindex="1" onkeypress="return isNumberKey(event,this);">-<input id="i_zip2" name="zip2" type="text" class="type4" value="" size="4" maxlength="4" tabindex="1" onkeypress="return isNumberKey(event,this);"></div>
								  <div class="col2"><a href="javascript:areaZip('i_zip1','i_zip2','i_setting_area2_id','i_cityName','i_townName', '<?php echo site_url('survey/getZipCode');?>');"><img src="<?php echo base_url(); ?>assets/image/zipcode_03.png" alt="yuubinkensaku" width="80"></a></div>
							</div>
					</div>
					
					<!-- ROW 11 -->
					<div class="row">
							<div  class="title">
								<table>
									<tbody>
										<tr>
											<th style="font-weight:900; padding:10px;"><label class="lb3">都道府県</label></th>
											<th width="50"><img class ="td-icon" src="<?php echo base_url(); ?>assets/image/title2.png" ></th>
										</tr>
									</tbody>
								</table>
							</div>
							<!--<label class="desc" id="title1" for="Field1">応募ID(14ケタ)<img src="<?php echo base_url(); ?>assets/image/2_PC_キムタオル_入力_03.png" width="20" height="10"></img></label>-->
							<div class="fieldColumn" >
									<!---ROW3-->
								  <div class="col1"><select id="i_setting_area2_id" name="setting_area2_id" >
																<option value="-1" selected selected>--末選択--</option>
																<option value="1">北海道</option>
																<option value="2">青森県</option>
																<option value="3">岩手県</option>
																<option value="4">宮城県</option>
																<option value="5">秋田県</option>
																<option value="6">山形県</option>
																<option value="7">福島県</option>
																<option value="8">茨城県</option>
																<option value="9">栃木県</option>
																<option value="10">群馬県</option>
																<option value="11">埼玉県</option>
																<option value="12">千葉県</option>
																<option value="13">東京都</option>
																<option value="14">神奈川県</option>
																<option value="15">新潟県</option>
																<option value="16">富山県</option>
																<option value="17">石川県</option>
																<option value="18">福井県</option>
																<option value="19">山梨県</option>
																<option value="20">長野県</option>
																<option value="21">岐阜県</option>
																<option value="22">静岡県</option>
																<option value="23">愛知県</option>
																<option value="24">三重県</option>
																<option value="25">滋賀県</option>
																<option value="26">京都府</option>
																<option value="27">大阪府</option>
																<option value="28">兵庫県</option>
																<option value="29">奈良県</option>
																<option value="30">和歌山県</option>
																<option value="31">鳥取県</option>
																<option value="32">島根県</option>
																<option value="33">岡山県</option>
																<option value="34">広島県</option>
																<option value="35">山口県</option>
																<option value="36">徳島県</option>
																<option value="37">香川県</option>
																<option value="38">愛媛県</option>
																<option value="39">高知県</option>
																<option value="40">福岡県</option>
																<option value="41">佐賀県</option>
																<option value="42">長崎県</option>
																<option value="43">熊本県</option>
																<option value="44">大分県</option>
																<option value="45">宮崎県</option>
																<option value="46">鹿児島県</option>
																<option value="47">沖縄県</option>
																</select></div>
							</div>
					</div>
					
					<!-- ROW 12 -->
					<div class="row">
							<div  class="title">
								<table>
									<tbody>
										<tr>
											<th style="font-weight:900; padding:10px;"><label class="lb3">市区郡（全角）</label></th>
											<th width="50"><img class ="td-icon" src="<?php echo base_url(); ?>assets/image/title2.png" ></th>
										</tr>
									</tbody>
								</table>
							</div>
							<!--<label class="desc" id="title1" for="Field1">応募ID(14ケタ)<img src="<?php echo base_url(); ?>assets/image/2_PC_キムタオル_入力_03.png" width="20" height="10"></img></label>-->
							<div class="fieldColumn" >
									<!---ROW3-->
								  <div class="col1"><input id="i_cityName" name="city" type="text" class="type7" value="" size="8" tabindex="1"></div>
							</div>
					</div>
					
					<!-- ROW 13 -->
					<div class="row">
							<div  class="title">
								<table>
									<tbody>
										<tr>
											<th style="font-weight:900; padding:10px;"><label class="lb3">町名等（全角）</label></th>
											<th width="50"><img class ="td-icon" src="<?php echo base_url(); ?>assets/image/title2.png" ></th>
										</tr>
									</tbody>
								</table>
							</div>
							<!--<label class="desc" id="title1" for="Field1">応募ID(14ケタ)<img src="<?php echo base_url(); ?>assets/image/2_PC_キムタオル_入力_03.png" width="20" height="10"></img></label>-->
							<div class="fieldColumn" >
									<!---ROW3-->
								  <div class="col1"><input id="i_townName" name="town" type="text" class="type7" value="" size="8" tabindex="1"></div>
							</div>
					</div>
					
					<!-- ROW 14 -->
					<div class="row">
							<div  class="title">
								<table>
									<tbody>
										<tr>
											<th style="font-weight:900; padding:10px;"><label class="lb3">電話番号</label></th>
											<th width="50"><img class ="td-icon" src="<?php echo base_url(); ?>assets/image/title2.png" ></th>
										</tr>
									</tbody>
								</table>
							</div>
							<!--<label class="desc" id="title1" for="Field1">応募ID(14ケタ)<img src="<?php echo base_url(); ?>assets/image/2_PC_キムタオル_入力_03.png" width="20" height="10"></img></label>-->
							<div class="fieldColumn" >
									<!---ROW3-->
								  <input id="i_tel1" name="tel1" type="text" class="type5" value="" size="8" maxlength="5" tabindex="1" onkeypress="return isNumberKey(event,this);">-<input id="i_tel2" name="tel2" type="text" class="type5" value="" size="8" maxlength="4" tabindex="1" onkeypress="return isNumberKey(event,this);">-<input id="i_tel3" name="tel3" type="text" class="type5" value="" size="8" maxlength="4" tabindex="1" onkeypress="return isNumberKey(event,this);">
							</div>
					</div>
					
					<!-- ROW 15 -->
					<div class="row">
							<div  class="title">
								<table>
									<tbody>
										<tr>
											<th style="font-weight:900; padding:10px;"><label class="lb3">購入先をお教え下さい。</label></th>
											<th width="50"><img class ="td-icon" src="<?php echo base_url(); ?>assets/image/title2.png" ></th>
										</tr>
									</tbody>
								</table>
							</div>
							<!--<label class="desc" id="title1" for="Field1">応募ID(14ケタ)<img src="<?php echo base_url(); ?>assets/image/2_PC_キムタオル_入力_03.png" width="20" height="10"></img></label>-->
							<div class="fieldColumn" >
									
								  <div class="col1"> <input type="text" class="type7" name="addressbuy" id="i_addressbuy" ></div>
							</div>
					</div>
					<!-- ROW 16 -> 19 -->
					<?php
					if ($id==2) {
						include_once("enq2.inc");
					} else {
						include_once("enq1.inc");
					}	
					?>
					
					 <!-- ROW 20 -->
					 <div class="row">
						<div  class="title">
							<table>
								<tbody>
									<tr>
										<th style="font-weight:900; font-style:bold;padding:10px;"><label class="lb3">商品に対するご要望はございますか。</label></th>
										<th width="50"><img class ="td-icon" src="<?php echo base_url(); ?>assets/image/title4.png" ></th>
									</tr>
								</tbody>
							</table>
						</div>
						<!--<label class="desc" id="title1" for="Field1">応募ID(14ケタ)<img src="<?php echo base_url(); ?>assets/image/2_PC_キムタオル_入力_03.png" width="20" height="10"></img></label>-->
						<div class="fieldColumn" >
								<textarea class="form4" id="i_comment" name="q10" onfocus="onFocus('comment');" onblur="outFocus('comment');"></textarea>
						</div>
					</div>
						<!-- ROW 21 -->
						 <div class="row">
						<div  class="title">
							<table>
								<tbody>
									<tr>
										<th style="font-weight:900; padding:10px;"><label class="lb3">応募規約 </label></th>
									</tr>
								</tbody>
							</table>
						</div>
						<!--<label class="desc" id="title1" for="Field1">応募ID(14ケタ)<img src="<?php echo base_url(); ?>assets/image/2_PC_キムタオル_入力_03.png" width="20" height="10"></img></label>-->
						<div class="fieldColumn" >
								<textarea id="kiyaku"  readonly>
＜応募規約＞
※本キャンペーンへの応募に際し、下記の規約にご同意いただきます様お願い申し上げます。
●本キャンペーンの告知チラシが同梱されていない商品につきましては､誠に勝手ながら本キャンペーンの対象外とさせていただきます。
●本キャンペーンの告知チラシはなくなり次第終了させていただきます。
●ご記入いただいたお客様情報は､賞品の発送､応募者･当選者への諸連絡と、今後弊社の製品やキャンペーンなどのご案内の為、ダイレクトメール（およびeメール）の発送やモニター発送、当社商品・サービスの開発の為に個人を特定しない統計資料を作成するために使用させていただきます。
●1つの応募IDにつきご応募は1回限りとさせていただきます。
●携帯、スマートフォンからのご応募はできません。
●インターネット接続料および通信料はお客様のご負担となります。また一部の機種・環境ではご応募できない場合があります。
●日本製紙クレシア社員の応募はできません。
●応募に関する必要事項で記入漏れがある場合、または虚偽の記載がある場合、その応募は無効とさせていただきます。また、当選者様の住所・転居先・電話番号が不明などの理由により連絡できない場合は当選を取り消させていただく場合がございます。
●賞品のデザイン・仕様は、やむを得ない事情により変更になる可能性がございます。予めご了承下さい。
●ご当選された賞品は一切返品･交換できかねます。
●日本製紙クレシア株式会社は､キャンペーン詳細確認に伴う使用機器･通信における障害､損傷についての責任を負いかねます。ご了承下さい。
							</textarea>
<!-- 20140829修正
							<input type="checkbox" name="ok" id="ok" value="1" onclick="onOKCheck();"><label for="ok">同意する</label>
-->
						</div>
						
					</div>
<!-- 20140829修正
					<div style="margin-top:10px;">
							<div align="center" id="oubo_off">
								<img src="<?php echo base_url(); ?>assets/image/title3.png" alt="oubo_btn" width="124" height="40" >
							</div>
-->						
							<div align="center" id="oubo_xxx">
								<input type="image" src="<?php echo base_url(); ?>assets/image/title3.png" alt="oubo_btn" width="124" height="40" onclick="onClick(); return false;">
							</div>
                                            
                                          
					</div>
			</form>
				
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